A Giant Step Backward

The Affordable Care Act survived the Supreme Court, but we should not celebrate yet. Congress designed the ACA to sell more health insurance policies, and it will, but we should not mistake health insurance for health care.

If you can’t afford a policy and government cutbacks remove your subsidy, your family doesn’t get health care. If you spent your last dollar on premiums with no money left for deductibles, your family doesn’t get health care. If illness prevents you from working and you lose coverage, your family doesn’t get health care.

The ACA will indeed succeed in selling more policies even with Supreme Court modifications. However, it will not make policies less expensive, care more affordable, or care more accessible.

The ACA is modeled directly upon Romney’s Massachusetts plan. What has happened there since 2006? Over 95 percent of Massachusetts residents now proudly own an insurance policy; however, health has not improved. Medically related bankruptcies have not gone down. Lives lost to treatable diseases have not decreased. And health care costs have continued to rise uncontrollably since the law was enacted.

We can expect no different from the ACA. Instead, the ACA deepened the dependence of healthy Americans on private insurance for access to health care. Dr. Marcia Angell, former editor of the New England Journal of Medicine, refers to the “tyranny of the healthy,” in which healthy, insured Americans fear any change will remove what they believe is their only protection against medically related financial catastrophe. What healthy Americans don’t appreciate is most personal bankruptcies are precipitated by medical crisis in families with health insurance at the time the crisis began. Oregonians suffered 12,000 medically related bankruptcies in 2009 affecting 34,000 family members. Most debts in collection agencies are medically related. The ACA changes nothing.

The ACA is giant step backward for health care. First, it enshrines private health insurance as the only way most Americans get health care. Next, it imposes huge impediments on states like Oregon which want better care than the ACA can provide. Any project must wait until 2017, long after spending millions of dollars for exchanges. Even then, special waivers are required.

Every other industrialized nation provides better care to more people for less money than we do. All use variants of publicly funded universal health care, many of them single payer. If we need to radically alter health care to produce better access for less money with better results, we should model ourselves on working systems, not dysfunctional systems. The ACA expands the most dysfunctional system in the world.

Reform advocates want Oregon to do better. We want health care access for everyone. We want lower health care costs. We want our dollars to improve the health of our families, not the health of insurance companies.

Please tell your state and U.S. representatives you want publicly funded, cost-effective health care for every Oregonian. The ACA won’t do it. It’s up to us.

About the Author

Samuel Metz, M.D., is a Portland anesthesiologist. He is a member of Mad As Hell Doctors and Physicians for a National Health Program; both organizations advocate for single-payer health care. This commentary was written for EW.